Surgery Consent Form

Surgery Consent Form

Surgery Consent Form

Surgery Consent Form

Please complete the form below and submit prior to your pets scheduled surgery.

Did your pet eat this AM?*

Is your pet current on Vaccines/Heartworm Test?

Is your pet current on Heartworm Prevention?*

Has your pet had any reactions, including any vaccine reactions?*

Is your pet currently on medications?*

For the safety of your pet, we require IV Catheters on all canine procedures. Cost for IV Catheter is $9.95

Pre-surgical blood screening

In order to reduce the risks involved with anesthetizing our patients, we perform a pre-surgical blood screen to detect abnormalities not evident on a routine examination. This bloodwork panel checks blood counts, platelet counts, and 10 blood chemistry levels to evaluate liver and kidney function, as well as blood glucose levels and blood protein levels. Evaluation of these levels allows us to FIRST see if anesthesia can be used safely on your pet, and SECOND allows us to adjust the dosing exactly what your pet needs for the safest possible anesthesia and recovery. Pre-anesthetic blood screening GREATLY reduces risks associated with any anesthesia. The charges for the blood screen will be added to your invoice.

Pain Control

The comfort, healing and safety of our patients is our number one concern during and after any surgical procedure. Pain medication helps improve healing and decrease inflammation, aiding in the comfort of your pet. A pain injection will be given to your pet while here for their procedure, and additional oral medication will be sent home with your for post operative care. Charges for the pain packages vary with the size of the patient and will be added to your invoice.

We are a flea free environment. If fleas are found, we will treat at owners expense.

All anesthetics and surgeries carry risks ranging from post-op nausea to sudden death. While these occurrences are very rare, they can happen even though protective measures are taken. I, (the owner/responsible party) for the above-described animal, have the authority to execute this consent, and am over 18 years of age. I understand there is an inherent risk in anesthesia and/or surgery. I agree with the above described procedure/care, and accept full responsibility and also full financial responsibility and understand all charges are to be paid in full upon completion.

I UNDERSTAND THAT IF WE ARE UNABLE TO REACH YOU BY PHONE DURING THE PROCEDURE, WE HAVE YOUR PERMISSION TO PERFORM ADDITIONAL PROCEDURES AS WE DEEM NECESSARY.

Recommended Surgical Options

Post-Surgical Laser Therapy (significantly decreases pain/swelling, and reduces healing time)*​​​​​​​

Intravenous Fluids (Faster recovery and safer surgery procedure. Critical in older pets.)*​​​​​​​

Wellness Packages, Canine or Feline

Vaccines*​​​​​​​

Heartworm Test*​​​​​​​

Feline Leukemia/FIV Test*​​​​​​​

Stool Exam for Intestinal Parasites*​​​​​​​

Dental Options

CET Oral Rinse/Water Additive (Slows buildup of bacteria)*​​​​​​​

DENTAL SEALANTS (Helps lengthen time between dentals)*​​​​​​​

Check any additional services wanted:

Nail Trim*​​​​​​​

Anal Glands Expressed*​​​​​​​

Microchip*​​​​​​​

Flea Prevention or Heartworm Prevention

Proheart Inj/Bravecto/Heartgard/Nexgard/Revolution (Cats)*​​​​​​​

Signature*​​​​​​​